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CLINICAL RESEARCH: CARDIAC IMAGING

Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography

Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California

Manuscript received March 3, 2008; revised manuscript received July 11, 2008, accepted July 14, 2008.

^_* Reprint requests and correspondence: Dr. Matthew J. Budoff, Harbor-UCLA Medical Center, 1124 W. Carson Street, RB2, Torrance, California 90502 (Email: mbudoff{at}labiomed.org).

Objectives: This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients.

Background: Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies.

Methods: In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC).

Results: During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD.

Conclusions: The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.

Key Words: outcomes • CT angiography • cardiac CT • prognosis • coronary calcium

Abbreviations and Acronyms   AUC = area under the curve   CAC = coronary artery calcification   CACS = coronary artery calcium score   CAD = coronary artery disease   CHD = coronary heart disease   CI = confidence interval   CTA = computed tomography angiography   EBT = electron beam tomography   HR = hazard ratio   MDCT = multidetector-row computed tomography   ROC = receiver-operator characteristic

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